Volkmann contracture

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The Volkmann contracture (after Richard von Volkmann ) is an ischemic contracture of the flexor muscles on the forearm.

These are soft tissue shortening - especially of the muscles  - due to insufficient blood flow and nerve damage from supracondylar fractures in childhood, constricting casts , extensive hematomas , edema (especially in the sense of a compartment syndrome ) or foreign material.

A characteristic of Volkmann's contracture is the flexion deformity - claw hand  - of the wrist in the context of fractures and dislocations in the elbow area .

root cause

Damage to arteries and the nerves supplying the forearm leads to corresponding muscular and neurological deficits.

Symptoms

  1. acute onset pain
  2. rock-hard, pressure-sensitive fabric
  3. Signs of reduced blood flow
  4. Restriction of movement

In the early stages, there is pain in the forearm with numbness and / or coldness in the fingers. In addition, a weakening of the pulse is usually found in combination with cyanosis of the skin. As the disease progresses, the forearm and hand muscles become atrophy, and this leads to flexion and pronation contractures of the hand. The metatarsophalangeal joints are hyperextended, the middle and end joints in flexion (claw position). The thumb is fixed in the extended position and adduction . The electrical excitability of the affected muscles has ceased.

therapy

Immediate removal of constricting plaster casts and possibly surgical splitting of the fascia .

literature